Evaluation of the use of a Renal Health application by kidney transplant recipients

Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.


Population
The study population was composed of the 1,823 individuals who downloaded the Renal Health application in the period under review.

Sample size
The sample consisted of the 225 individuals who had subscribed to the kidney transplant section during the study period.

Study variables
The following demographic data were collected: age, sex, and Brazilian region of residence. For information about the ease and usability of the application, the following data were assessed: number of downloads, input of personal data, and time of use (number of accesses and period of use). The analyzed data related to selfmonitoring were: weight, blood pressure, blood glucose, serum creatinine, medication schedule, alarm activation, scheduling of appointments and examinations.

Data collection
Data were extracted from the PostgreSQL database, which hosts the content of the Renal Health application, available for researchers through the University of Fortaleza's server.

Data treatment and analysis
Extraction, compilation, and descriptive analysis of the data were performed using the Microsoft Power BI

Ethical aspects
The utilization of data from the Renal Health application for research was consented to by the individuals who agreed by signing the Terms of Free and Informed Consent form, sent after download, and approved by the Research Ethics Committee of the Universidade de

Results
The individuals registered in the kidney transplant recipient section of the Renal Health application were predominantly from the Southeast (44.9%) and Northeast (28.9%) regions of Brazil. The mean age was 36±11 years, and female sex prevailed (59.1%).
Of the total number of registered individuals, 146 (64.9%) did not enter information into the application   When analyzing the entered data of individuals who used the application for one day (63.3%), the most frequently explored sections were: creatinine level (62%), weight (52%), blood pressure (50%), and medication intake scheduling (42%).

Discussion
To the best of our knowledge, this is the first Brazilian study on the use of a treatment support application. The interest, according to the number of downloads and registration, and the use, in terms of frequency and preferences, of the section for kidney transplant recipients of the Renal Health app were analyzed. Although the application was created using an inclusive process (22) , i.e., the application was developed with the participation of patients and there was excellent acceptability (23) , a low frequency of use was found after the application was launched in online stores, which may be associated with dissemination of the application, the lack of encouragement by health professionals to use it, and the need for manual data entry.  (27) . High initial acceptance rates and low actual use of the tools over time were also found among lung transplant recipients (4) .
Our findings showed that, among individuals who entered some data into the application, only 13.9% continued using it for more than 100 days. Low or declining engagement in eHealth applications has been reported previously in different groups, such as lung (5)

Conclusion
The kidney transplant section of the Renal Health application sparked interest among the young population.
The main functionalities used by the patients were for recording weight, scheduling appointments, medication intake, and creatinine level recording. However, the application showed low adherence throughout the months evaluated.